This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
> Reduced 29% at ImplementationReduced 29% at Implementation
• 1998: 46% of Fee Schedule CF 1998: 46% of Fee Schedule CF >Based on Medicare Based on Medicare historicalhistorical relationship since 1992 relationship since 1992
>National Average Medicare Anesthesia CF $16.88National Average Medicare Anesthesia CF $16.88
• Calculated “Hourly Rate” ComparisonsCalculated “Hourly Rate” Comparisons• ““Building Block” Analysis of Anesthesia ServicesBuilding Block” Analysis of Anesthesia Services• Medicaid vs. Medicare ComparisonsMedicaid vs. Medicare Comparisons• Relationship to Commercial RatesRelationship to Commercial Rates• Cross Specialty Impact of Common RBRVS MultiplesCross Specialty Impact of Common RBRVS Multiples• Pure Medicare Anesthesia Practice ModelPure Medicare Anesthesia Practice Model
• Many CPT descriptors include time in definition Many CPT descriptors include time in definition of serviceof service>e.g., “each 15 min.” “up to one hr.” etc.e.g., “each 15 min.” “up to one hr.” etc.
• Anesthesia fee determination includes timeAnesthesia fee determination includes time• Compare anesthesia hourly rate to other Compare anesthesia hourly rate to other
Building Block Analysis of Anesthesia ServicesBuilding Block Analysis of Anesthesia Services
• Anesthesia Formula Is Inclusive & GlobalAnesthesia Formula Is Inclusive & Global• Preop, Intraop and Postop Care IncludedPreop, Intraop and Postop Care Included
• Only Unusual Procedures Separately RecognizedOnly Unusual Procedures Separately Recognized
• Constituent Services Individually Valued in Fee Constituent Services Individually Valued in Fee ScheduleSchedule
• Compare Anesthesia Formula to Sum of Compare Anesthesia Formula to Sum of Constituent PartsConstituent Parts
• Medicaid programs insure indigentMedicaid programs insure indigent• Typically Typically lowestlowest physician payment rates physician payment rates• Low payment rates limit access to servicesLow payment rates limit access to services• Many programs use standard “base plus time” Many programs use standard “base plus time”
anesthesia unit methodologyanesthesia unit methodology• National survey of Medicaid anesthesia ratesNational survey of Medicaid anesthesia rates
• Comparable methodology, data available: 29 statesComparable methodology, data available: 29 states
• Relationship of Medicaid anesthesia rate to MedicareRelationship of Medicaid anesthesia rate to Medicare
Reasonable Charges in AnesthesiaReasonable Charges in Anesthesiaperper Federal RegisterFederal Register 63:54756, 1998 63:54756, 1998
• U.S. Dept. of Veterans Affairs health systemU.S. Dept. of Veterans Affairs health system• VA transition from collecting “costs” to VA transition from collecting “costs” to
“charges” from private insurers“charges” from private insurers• 200-page report establishing “reasonable 200-page report establishing “reasonable
charges” - including physician servicescharges” - including physician services• Anesthesiology chargesAnesthesiology charges
>Fees for all “0” series anesthesia codesFees for all “0” series anesthesia codes
>Conversion factor imputed from St. Anthony’s base Conversion factor imputed from St. Anthony’s base units and time units from Medicare databaseunits and time units from Medicare database
Hsiao Pure Medicare Practice ModelHsiao Pure Medicare Practice Model
• NEJMNEJM 1993: Hsiao Assesses Impact of 1993: Hsiao Assesses Impact of RBRVS-based Medicare Fee ScheduleRBRVS-based Medicare Fee Schedule
• Multiple Specialties Providing Typical Service Multiple Specialties Providing Typical Service Full Time to Medicare BeneficiariesFull Time to Medicare Beneficiaries
• Estimate of Annual EarningsEstimate of Annual Earnings• McMenamin Adaptation of Method to Assess McMenamin Adaptation of Method to Assess
AnesthesiologyAnesthesiology
Hsiao, W.C., Dunn, D.L., Verrilli, D.K. Assessing the Implementation of Physician Payment Reform, N Eng J Med.1993; 328:928.
Hsiao, W.C., Dunn, D.L., Verrilli, D.K. Assessing the Implementation of Physician Payment Reform, N Eng J Med.1993; 328:928.
• Has a distorted relationship with commercial third Has a distorted relationship with commercial third party ratesparty rates
• Is frequently lower than Medicaid ratesIs frequently lower than Medicaid rates• Is internally inconsistent with fee schedule Is internally inconsistent with fee schedule
componentscomponents• Produces a disproportionate impact when used as the Produces a disproportionate impact when used as the
basis for commercial paymentbasis for commercial payment• Results in compensation incompatible with the nature Results in compensation incompatible with the nature
& risks of service& risks of service
The Medicare anesthesia conversion factor:The Medicare anesthesia conversion factor:
Alternative Approaches to Implementing RBRVS Alternative Approaches to Implementing RBRVS Methodology in AnesthesiaMethodology in Anesthesia
• Index anesthesia CF to other specialties’ Index anesthesia CF to other specialties’ discount from chargesdiscount from charges
• Index anesthesia CF to other specialties’ Index anesthesia CF to other specialties’ discount (if any) from prevailing discount (if any) from prevailing commercial/managed care ratescommercial/managed care rates
• Apply a “correction factor” to the Medicare Apply a “correction factor” to the Medicare anesthesia CF before applying a common anesthesia CF before applying a common multipliermultiplier
• Retain existing anesthesia RVG and CFRetain existing anesthesia RVG and CF